Death of the sole doctor at Takano Hospital 6 years after the Fukushima nuclear crisis—who is responsible for health care delivery in the Fukushima disaster zone?

It has been 6 years since the earthquake, tsunami and subsequent Fukushima Daiichi nuclear power plant (FDNPP) accident struck the northeastern area of Japan in March 2011.1 Futaba District (Figure 1) is located in the coastal area of Fukushima housing the FDNPP, and was affected by all three disasters.1 Although the original population of Futaba District was approximately 72 000, almost all local residents were forced to evacuate in the immediate aftermath of the FDNPP accident.1 In long-term recovery efforts, the Central Government of Japan and district municipalities have started to lift evacuation orders in parts of the previously inhabitable exclusion zone for full-time residency since September 2011.2 However, the current population of Futaba District remains at approximately 11 000, and the delayed recovery of medical services is one of the biggest reasons that local residents cite for their reluctance to return. The district suffers from physician undersupply despite the prior existence of 6 hospitals and 48 clinics pre-disaster.3,4 All of them, apart from one hospital, were pushed into closure immediately after the disaster. Now, 5 years later, only 1 hospital and 13 clinics are open in Futaba District.3 Map of Futaba District. Hirono Town is located in the southern part of Futaba District. FDNPP, Fukushima Daiichi nuclear power plant. To make matters worse, a critical event has occurred which could further compromise local medical service in Futaba District. Dr Hideo Takao, the director and sole full-time doctor of the privately-run Takano Hospital (Figure 1), died at the age of 81 on 30 December 2016.5 Takano Hospital, located 22 km to the south of the FDNPP and in Hirono Town, is the only hospital in Futaba District, and has 65 and 53 beds in general and psychiatry wards, respectively. Although an evacuation order was issued for Hirono Town after the disaster, the hospital did not close for a single day and has continued to provide medical care. Until his death, Dr Takano demonstrated constant support to the recovery of Futaba District by playing a surprising number of roles despite his age, such as taking over 100 night shifts per year, treating patients transferred to the hospital via ambulance, and doing the work of an X-ray technician, in addition to the day-time management of all inpatients and outpatients.5 On 31 December 2016, we launched a campaign to save Takano Hospital. This campaign has been covered by multiple mass media outlets, provoking both sympathy for Dr Takano’s life dedicated to medical care in a disaster-stricken and underserved area, and concern for the situation at his hospital, among both medical and non-medial communities.5 Resultantly, more than 20 doctors from all across Japan applied to work as unpaid volunteers for the month of January 2017,5 and a 36-year-old doctor stepped up to take the position of temporary director from February to March 2017.6 However, the presence of doctors itself will not solve all obstacles in achieving the long-term survival of Takano Hospital and provision of medical services to this area. Although profit is essential for private medical institutions, Takano Hospital struggled to make a profit post-disaster due to severe de-population in the district and increased labor costs owing to a shortage of health care personnel. Additionally, given Dr Takano’s multifaceted roles, the hospital will need to hire multiple medical staff members to fully make up for his absence, putting further pressure on its business-side, which could lead to eventual bankruptcy. However, neither the Fukushima Prefectural Office nor the Central Government of Japan intends to offer sufficient financial support at this time under the pretext that it is unfair to support a specific private medical institution.7 Given the passive attitude from the government, the long-term survival of Takano Hospital is unlikely. The influence of Takano Hospital’s closure on the hospitalized patients would be particularly enormous. In total 103 patients were hospitalized as of 7 February 2017, and considering the post-disaster changes in familial and social structures in the district, many of them may not return home and will need to be transferred to other facilities if the hospital is closed. In the coastal area of Fukushima, where the damage of the FDNPP accident was largest, many young people have evacuated for fear of potential radiation exposure, while elderly generations have remained.8 Resultantly, the area has significantly aged, and it has been found that the elderly are now less likely to receive informal care from younger family members at home compared to before the disaster.8 Indeed, in Hirono Town, the proportion of residents over 65 years old was 23.9% in 2010, yet it rose to 26.2% in 2015.9 Simultaneously, the proportion of those under 15 years old was 14.1% in 2010, and declined to 5.9% in 2015.9 In these situations, the hospital may be able to compensate for decreased informal care in the local community through the provision of long-term medical care to the socially isolated elderly. Further, the current crisis of Takano Hospital illustrates structural issues of health care delivery in medically underserved areas. As shown in the case of Takano Hospital, medical care in such circumstances is often a result of the effort and self-sacrifice of one heroic figure, meaning that an entire system can collapse if that person disappears. Health care is a social infrastructure, and it is imperative to create a system that is not excessively dependent on the self-sacrifice of individual doctors to ensure stable provision of medical care to local residents. Given that the Central Government of Japan promotes the return of residents to disaster areas, we suggest that taking initiative to support the local medical system should be an administrative priority. Medical care in the areas struck by the Fukushima nuclear crisis has been suboptimal for the 6 years following the disaster. It is necessary for the relevant stakeholders to recognize this issue and take measures to improve healthcare infrastructure and human resources. Nuclear power plants are currently being built across the world.10 Our experience highlights the long-term impact a nuclear disaster can have on local medical services, and we believe this is something that all health care workers and policy planners in areas potentially affected by nuclear power plant accidents should be aware of. Institutional review board statement: The Minamisoma Municipal General Hospital Institutional Review Board waived the review of this study, because it did not include any patients. Informed consent statement: This study did not involve any patients. We thank Mr Masatsugu Tanaki, Mr Satoshi Endo, Ms Mio Takano, Dr Yujiro Nakayama and all health care providers engaged in the support of Takano Hospital. None. Conflict of interest: None declared.